The herbal remedies for hot flashes with the most research behind them are black cohosh and red clover, both linked to fewer hot flashes in meta-analyses, followed by sage, which has a strong traditional following and a promising trial. Evening primrose, ashwagandha and turmeric have smaller supporting studies. Here’s what each herb is, what the studies found, and the safety points to know before you start.
Disclosure: My husband, Brandon, does freelance marketing work for Immunotec, the company that makes She+. I got She+ free as an early tester.
- Black cohosh: a 2023 meta-analysis of 22 studies and 2,310 women found fewer hot flashes and better overall symptoms vs placebo.
- Red clover: about 1.7 fewer hot flashes a day vs placebo in a 2021 meta-analysis.
- Sage: a once-daily fresh sage tablet cut hot flash scores by 64% over eight weeks in a 2011 trial.
- Herbs aren’t risk-free. Black cohosh has rare liver reports, ginger can interact with blood thinners, and most of these herbs aren’t for pregnancy.
- I use She+ by Immunotec, which combines black cohosh, red clover and ginger in one daily jelly stick.
Why women turn to herbs
Hot flashes happen because falling estrogen makes the brain’s temperature center extra sensitive, so small rises in body heat set off a flush and sweat. (I explain it in what causes hot flashes.) Some herbs contain plant compounds with a mild estrogen-like effect, and others appear to act in different ways. Many women like starting with plants before considering prescriptions.
That was me. About a year ago I started having low energy, worsening sleep and hot flashes, mostly at night. Magnesium didn’t help me. What did help was a combination of two of the herbs below, which I’ll get to. You can read the whole story in my She+ review.
The herbs, one by one
Black cohosh
Most studiedA root from a North American plant in the buttercup family, used by women for generations. It’s the most researched herb for menopause. A 2023 meta-analysis pooling 22 studies and 2,310 women found black cohosh extracts significantly improved hot flashes, overall menopause symptoms and physical symptoms compared with placebo (Menopause, 2023).
It may help sleep too. In a six-month trial using in-home sleep testing, women taking black cohosh had better sleep efficiency and 15.8% less time awake after falling asleep than women on placebo (Climacteric, 2015). Randomized trials have typically used 128 to 160 mg of extract a day (NIH ODS). More detail is in my black cohosh guide.
Safety: The most common side effects are mild stomach upset and rash. There are rare reports of liver injury worldwide, and the NIH notes no causal link has been proven, but stop and call your doctor if you notice yellowing skin or eyes, dark urine or stomach pain (NIH ODS). See black cohosh side effects.
Red clover
Clinically studiedA legume related to peas and beans, rich in isoflavones, plant compounds whose structure resembles estrogen (NCCIH). A 2021 meta-analysis of eight trials found women taking red clover had about 1.7 fewer hot flashes a day than women on placebo, with the clearest results in women having five or more a day, at isoflavone doses of 80 mg a day or more over 12 weeks (Nutrients, 2021). A 2026 analysis of nine trials found a significant reduction in hot flash frequency (EJOG, 2026).
Safety: Extracts were used in studies lasting up to two years and appear well tolerated. Red clover may be unsafe in pregnancy and breastfeeding (NCCIH). Ask your doctor first if you’ve had estrogen-sensitive breast cancer.
Sage
Traditional favoriteCommon garden sage (Salvia officinalis) has long been used for sweating and hot flashes, and it’s one of the most recommended remedies on UK menopause forums, where several women said sage tablets helped their night sweats (Mumsnet). In a 2011 trial of 71 women with at least five hot flashes a day, a once-daily fresh sage tablet reduced the intensity-weighted hot flash score by 50% within four weeks and 64% by eight weeks. Severe hot flashes fell by 79%, and the tablet was very well tolerated (Adv Ther, 2011).
Safety: Likely safe in food amounts, and larger amounts were used safely in studies of up to eight weeks. Common sage contains thujone, which can be toxic in large amounts, so avoid high doses or long-term heavy use, and skip it in pregnancy (NCCIH).
Evening primrose oil
SeverityAn oil from the seeds of a North American wildflower. In a six-week randomized trial of 56 women, those taking 500 mg capsules twice daily saw hot flash severity improve by 42%, significantly better than placebo, along with gains in social activities and relationships on a daily-interference questionnaire (Arch Gynecol Obstet, 2013).
Safety: Generally well tolerated; the most common side effects are stomach upset, nausea or diarrhea (NCCIH).
Ashwagandha
PerimenopauseAn herb from Ayurvedic tradition. In an eight-week randomized trial of 100 perimenopausal women, 300 mg of root extract twice daily significantly reduced total menopause symptom scores and improved menopause quality of life compared with placebo (J Obstet Gynaecol Res, 2021).
Safety: May be safe for up to about three months. Side effects can include drowsiness and stomach upset, and there are rare liver injury reports. Avoid it in pregnancy and with thyroid or autoimmune conditions, and ask about interactions with diabetes, blood pressure, thyroid and sedative medicines (NCCIH).
Turmeric (curcumin)
Newest researchA brand-new pilot trial of 40 postmenopausal women found that 1,000 mg a day of curcuminoids reduced hot flashes by about 7 per week compared with placebo after 12 weeks, with good tolerability (BMC Complement Med Ther, 2026).
Safety: Can cause stomach upset. Highly absorbable curcumin products have been linked to liver injury in some people, so stop and call your doctor if you notice fatigue, dark urine or yellowing skin. Turmeric supplements may be unsafe in pregnancy (NCCIH).
Ginger
Digestive comfortGinger is best known for easing nausea and period cramps, and it’s widely studied for its anti-inflammatory and antioxidant properties (NCCIH). It’s a common partner herb in menopause blends for digestive comfort.
Safety: Ginger may raise bleeding risk if you take warfarin (BJCP, 2021).
Quick comparison
| Herb | Key study finding | Main safety note |
|---|---|---|
| Black cohosh | Fewer hot flashes vs placebo across 22 studies | Rare liver reports |
| Red clover | About 1.7 fewer hot flashes a day | Not for pregnancy; ask with breast cancer history |
| Sage | Hot flash score down 64% in 8 weeks | Avoid large doses and pregnancy |
| Evening primrose | Severity improved 42% | Stomach upset |
| Ashwagandha | Lower total menopause symptom scores | Thyroid, pregnancy, rare liver reports |
| Turmeric | About 7 fewer hot flashes a week | Liver reports with high-absorption forms |
The herbal combination I use
She+ by Immunotec combines the two most studied herbs, black cohosh and red clover, with ginger and glucomannan (a konjac fiber) in an apple blueberry jelly stick. I take one a day. About two months in, my Oura sleep scores went from constant wake-ups to the 80s and 90s, my energy is back, and my hot flashes have reduced a lot. In Immunotec’s 30-day tester group, 95% noticed changes and 59% noticed them in the first week. Individual results vary. It isn’t hormone replacement therapy (HRT). Here’s my honest She+ review with all the details.
Tips for trying an herb
- Give it time. Most trials ran 6 to 12 weeks. Track your hot flashes in a notebook or app so you can see real change.
- Try one new thing at a time. That way you’ll know what’s working.
- Pair it with cooling habits. Layers, a cool bedroom and a fan help no matter what else you take. See my list of natural ways to reduce hot flashes.
- Look at the whole picture. Hot flashes often come with sleep and mood changes. My perimenopause symptoms list covers them all, and hot flash treatments covers prescription options.
Talk to your doctor first if
- You have liver problems. Black cohosh, ashwagandha and high-absorption turmeric have rare liver injury reports. Stop and call your doctor if you notice yellowing skin or eyes or dark urine.
- You’ve had breast or uterine cancer. Safety of black cohosh and red clover isn’t settled for hormone-sensitive cancers (NCCIH).
- You take blood thinners. Ginger may raise bleeding risk with warfarin.
- You’re pregnant or breastfeeding. Black cohosh, red clover, sage, ashwagandha and turmeric supplements aren’t considered safe.
- Your symptoms are severe or unusual. Drenching night sweats, fever or weight loss should be checked, since they can have other causes.
Frequently asked questions
What is the best herbal remedy for hot flashes?
Black cohosh and red clover have the most research, including meta-analyses showing fewer hot flashes compared with placebo. Sage has a strong traditional following and a promising trial.
How long do herbal remedies take to work for hot flashes?
In studies, sage showed changes within four weeks, and red clover’s clearest results came at 12 weeks. Give any herb at least a month or two.
Can I take black cohosh and red clover together?
Many menopause products combine them, including She+. Ask your doctor first if you have liver problems or a history of hormone-sensitive cancer.
Are herbal remedies safer than hormone therapy?
They carry different risks, not zero risk. Talk with your doctor about your health history so you can weigh the options together.
Is sage tea as good as sage tablets?
The 2011 trial used a standardized fresh sage tablet. Sage tea in normal amounts is likely safe, but the dose is less predictable.
Sources
- Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis. Menopause, 2023. PubMed
- Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric, 2015. PubMed
- Black cohosh fact sheet for health professionals. NIH Office of Dietary Supplements. NIH ODS
- Black cohosh. National Center for Complementary and Integrative Health. NCCIH
- Red clover. National Center for Complementary and Integrative Health. NCCIH
- Clinical meaningfulness of red clover extract to relieve hot flushes. Nutrients, 2021. PubMed
- The effectiveness of red clover on hot flash in menopausal women: a GRADE-assessed meta-analysis. Eur J Obstet Gynecol Reprod Biol, 2026. PubMed
- First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes. Adv Ther, 2011. PubMed
- Sage. National Center for Complementary and Integrative Health. NCCIH
- The effect of oral evening primrose oil on menopausal hot flashes: a randomized clinical trial. Arch Gynecol Obstet, 2013. PubMed
- Evening primrose oil. National Center for Complementary and Integrative Health. NCCIH
- Effect of an ashwagandha root extract on climacteric symptoms in women during perimenopause. J Obstet Gynaecol Res, 2021. PubMed
- Ashwagandha. National Center for Complementary and Integrative Health. NCCIH
- Curcuminoid supplementation for vasomotor symptoms in postmenopausal women: a pilot randomized trial. BMC Complement Med Ther, 2026. PubMed
- Turmeric. National Center for Complementary and Integrative Health. NCCIH
- Ginger. National Center for Complementary and Integrative Health. NCCIH
- Warfarin and food, herbal or dietary supplement interactions: a systematic review. Br J Clin Pharmacol, 2021. PubMed
- Mumsnet menopause forum: Natural remedies for night sweats
Denise Walsh
Michigan woman in perimenopause, writing about what’s actually helped her sleep, energy and hot flashes.
Jesse Ovlasuk, RN
ICU registered nurse in Grand Rapids. Reviews every post for medical accuracy and safety.
This article reflects one person’s experience and is for general information only. It is not medical advice. Talk with your healthcare provider before starting any supplement. *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Leave a Reply